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Hysteroscopic cannulation for proximal tubal obstruction: a change for the better?
Objective:
To compare overall the results of hysteroscopic tubal cannulations and resection anastomosis for proximal tubal occlusion.
Design:
Nonrandomized retrospective analysis of patients operated on by two surgeons.
Setting:
University and large tertiary referral private practice.
Patients:
Seventy-four patients over a 10-year period, with bilateral or unilateral proximal occlusion of a single tube.
Interventions:
Hysteroscopic cannulation, resection anastomosis, or both.
Main Outcome Measures:
Intrauterine and ectopic pregnancy rates, long-term tubal patency, and pathology of tubal segments.
Results:
In patients with normal distal tubes, intrauterine pregnancy rates were similar (12/21, 57% versus 12/24, 50%) and ectopic pregnancy rates were lower (0/21, 0% versus 7/24, 29.1%) in the cannulation group. One-year patency rates in nonpregnant patients was higher in the anastomosis group (12/15, 80% versus 3/8, 33%).
Conclusions:
Hysteroscopic cannulation should be first choice in the management of proximal tubal obstructions in selected patients. It may be a treatment option for delayed occlusion after successful cannulation or resection anastomosis.